不同Narcotrend指数下气管插管应激反应的观察

Observation of Stress Reaction of Endotracheal Intubation Under Different Narcotrend Index

目的比较不同Narcotrend指数(NTI)下全麻患者诱导期气管插管的应激反应。方法选择60例ASAⅠ~Ⅱ级气管插管全麻患者,按照数字表法随机分为两组:浅麻醉组(NL组)和深麻醉组(ND组),每组各30例。NL组患者麻醉诱导时NTI控制在64~37范围内,相应麻醉深度级别(NTS)为D0~D2;ND组患者麻醉诱导时NTI控制在36~13范围内,相应NTS为E0~E2。记录麻醉麻醉诱导前(T0)、气管插管前(T1)、气管插管后1 min(T2)、3 min(T3)、5 min(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)及NTI值。气管插管后SBP或HR升高幅度大于基础值20%以上认定为发生心血管反应,记录心血管反应发生情况。结果两组患者T0时HR、SBP、DBP比较差异无统计学意义(P>0.05)。ND组T1~T4时HR、SBP、DBP比T0时下降(P<0.05);NL组T1时HR、SBP、DBP比T0时降低(P<0.05),T2~T3时HR、SBP、DBP比T0时增快或升高(P<0.05);NL组T2~T4时HR、SBP、DBP比ND组增快或升高(P<0.05)。NL组心血管反应发生率为60%,ND组无心血管反应发生,差异有统计学意义(P<0.05)。结论Narcotrend监测下的深麻醉状态,能有效减轻气管插管引起的机体应激反应,维持血流动力学平稳。

Objective To compare the stress responses of tracheal intubation during induction of general anesthesia in patients with different narcotrend index(NTI).Methods Sixty patients ASA physical statusⅠ~Ⅱwith endotracheal intubation under general anesthesia,in accordance with the random number table method were randomly divided into two groups with 30 cases each:lighter anesthesia group(group NL)and deeper anesthesia group(group ND).NTI in group NL was controlled within the range of 64~37,and the corresponding level of anesthesia depth Narcotrend stage(NTS):D0~D2;NTI in Group ND was controlled within the range of 36~13,and NTS:E0~E2.Heart rate(HR),Systolic blood pressure(SBP),Diastolic blood pressure(DBP)and NTI were measured before induction(T0),before tracheal intubation(T1),and at 1 min(T2)、3 min(T3)、5min(T4)after intubation.It was identified as cardiovascular reaction,when SBP or HR after tracheal intubation increased by more than 20%of the basal value,then record the occurrence of cardiovascular reaction.Results There were no significant difference in HR、SBP and DBP at T0 time point between two groups(P>0.05).HR、SBP and DBP at T1~T4 were lower than those at T0 in group ND(P<0.05).HR、SBP and DBP at T1 were lower than those at T0(P<0.05),and were higher at T2~T3 than those at T0 in group NL(P<0.05).HR、SBP and DBP at T2~T4 were higher in group NL than those in group ND(P<0.05).The incidence of cardiovascular disease was 60%in group NL and no cardiovascular reaction occurred in group ND(P<0.05).Conclusion Maintaining the deep anesthesia guided by Narcotrend could be more effectively attenuate the stress reaction caused by tracheal intubation,and maintain the stability of hemodynamic during anesthesia induction.